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Fentanyl Exposure Risks for Law Enforcement and Emergency Response Workers

Fentanyl is a powerful synthetic drug that is similar to morphine and heroin, but is 50 to 100 times more potent. Fentanyl and its analogs, such as carfentanil, can pose a potential hazard to law enforcement, emergency medical personnel, and firefighters who could come into contact with these drugs through the course of their work day. While there are important questions about the risks of different types of exposures (and resultant health effects) that might occur during law enforcement and emergency response activities, workers involved in these types of activities leading to potential exposures should take prudent precautions. NIOSH provides interim recommendations for routine law enforcement activities following an arrest or execution of a search warrant—such as evidence collection—that may lead to potential exposures to fentanyl or related compounds.

Exposure routes are likely to vary based on the form of fentanyl and the circumstances of the event. Exposure through the skin, inhalation, and ingestion are all possible routes of exposure. Inhalation exposures can quickly result in respiratory depression. Recent news reports point to law enforcement officers being exposed to fentanyl through skin absorption while on the job. Additional research is needed to better understand the possible routes of exposure and means to prevent those exposures. Fentanyl and its analogs do not have established occupational exposure limits (OELs).

Standard safe work practices must be applied to all operations where fentanyl or its analogs are known or suspected to be present, just as they are applied to any law enforcement operation involving potential narcotics, such as a methamphetamine lab or heroin. Law enforcement officers should not eat, drink, or smoke in the area of the suspected fentanyl and should wash their hands and inspect clothing for contamination after performing any activity potentially involving fentanyl. It is important that a job hazard analysis be performed to determine the most appropriate level and type of personal protective equipment (PPE) to protect against respiratory and dermal hazards for specific tasks. At a minimum, NIOSH recommends the use of a P-100 half-mask filtering facepiece respirator (or higher), gloves, eye protection, and protective clothing to protect against possible fentanyl exposure. In the event of a large spill or release of fentanyl, NIOSH recommends that law enforcement vacate the area and call a hazardous materials incident response team for support.

The U.S. Drug Enforcement Administration (DEA) recommends that law enforcement do not field test drugs if fentanyl is suspected (https://www.dea.gov/divisions/hq/2016/hq061016.shtml). Wearing the appropriate PPE, the suspected substance should be collected and sent to a laboratory for analysis.

Questions remain about the risks of exposures to fentanyl and its analogs. For example do dermal exposures represent a significant health risk for first responders, should an OEL be established for fentanyl, and are there other activities that would benefit from NIOSH providing best work practices?

Would your workplace benefit from a Health Hazard Evaluation specific to the issues surrounding fentanyl? The NIOSH Health Hazard Evaluation Program has previously conducted research on possible workplace hazards and provided recommendations to law enforcement and emergency responders to protect against possible drug-related exposures other than fentanyl. Below are a few examples of evaluations conducted with law enforcement. For more information on the Health Hazard Evaluation program including how to request an evaluation visit the website.

We would like to hear from law enforcement and emergency services personnel about the safety procedures and practices that you use when you suspect the presence of fentanyl or carfentanil. Do you have information on the effectiveness of your safety procedures and practices or other issues related to fentanyl that you’d like to share with the broader law enforcement community? Please provide your input in the comment section below and let us know if you’re interested in hearing more about the NIOSH Health Hazard Evaluation Program.

20 comments on “Fentanyl Exposure Risks for Law Enforcement and Emergency Response Workers”

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Its good to see law enforcement agencies becoming more aware of the dangers of their jobs.
It looks like HAZCOM, PPE, and Occupational Health and Safety Management needs to be addressed in future training to help protect law enforcement in these times of new occupational hazard exposures

Fentanyl exposure through the skin is as significant a risk as inhalation or ingestion exposure. Why do you think they sell fentanyl patches? I have seen an acceptable surface limit for dermal contact exposure of 50 nanograms per square centimeter. This is less than you will be able to see. Please do not underestimate the risk.

NIOSH is not aware of any existing exposure standards for narcotics. Concerning PPE recommendations for working with narcotics, NIOSH recommends following safe work practices similar to those made for fentanyl. Employers should perform a risk assessment at each crime or overdose scene to determine the appropriate level of PPE required to protect the first responder. In areas of the country where widespread use of fentanyl has been documented, NIOSH recommends that first responders assume that fentanyl or its analogs may be present and follow our interim recommendations. See this webpage for more on NIOSH’s PPE recommendations: https://www.cdc.gov/niosh/topics/fentanyl/risk.html

In addition to law enforcement, public works and parks folks are at risk as these materials could be used and discarded in parks and along the public right of way. Given the increasing risk of these opioid cocktails for fast and lethal consequences, we should be raising awareness in those communities as well. We in the national Local Technical Assistance Program (funded by the Highway Bill) stand ready to deliver that awareness if appropriate materials become available. A perfect delivery to local agency personnel would be through the development of a Tailgate Safety Meeting packet for supervisors to use in carrying out the briefing.

What sort of respiratory protection can be recommended for regular patrol officers if they happened to suspect that perpetrator has Fentanyl or related substances, My office makes safety and health recommendations to the nations largest police department, all patrol officers have been instructed to call specialized unit for help when it comes to Fentanyl but what about initial interaction ?

Law enforcement officers who suspect fentanyl may be present but do not observe fentanyl or drug paraphernalia should consider nitrile gloves at a minimum. If fentanyl is observed, the precautions outlined in the blog above should be followed.

We would welcome the opportunity to discuss particular scenarios your officers may face and how best to protect them when they suspect fentanyl may be present during their initial interaction. Please feel free to contact me at ezh7@cdc.gov.

LE K9’s are at risk as well. Those trained to detect narcotics are many times the first contact to this drug exposure. Both handler and partner must be alert to the dangers and prepared to administer an antidote. Narcan is not just for the addicted but the survival of the people who respond.

Staff that work in our Nations jails are at high risk of exposure; inmate searches, inmate mail, personal property searches and inventory. Gloves are a common practice amongst jail staff but other PPE is typically a planned event…unfortunately in a jail environment events are often unplanned therefore leaving jail professionals unprotected. Information regarding safety of jail staff is scarce…

Thank you for your comment. While we don’t specifically mention jail staff, we consider them part of law enforcement. Our updated topic page Fentanyl: Preventing Occupational Exposure to Emergency Respondershttps://www.cdc.gov/niosh/topics/fentanyl/risk.html contains recommendations for “Pre-Hospital Care” and “Law Enforcement”. Those two categories cover prison job activities of dealing with people who may be hiding fentanyl on their person and become violent when confronted.

What recommendations do you have for hospital/emergency care setting staff with regard to PPE? How would the following be applied in emergency care settings, and will CDC guidance be updated?

“Standard safe work practices must be applied to all operations where fentanyl or its analogs are known or suspected to be present, just as they are applied to any law enforcement operation involving potential narcotics, such as a methamphetamine lab or heroin. Law enforcement officers should not eat, drink, or smoke in the area of the suspected fentanyl and should wash their hands and inspect clothing for contamination after performing any activity potentially involving fentanyl. It is important that a job hazard analysis be performed to determine the most appropriate level and type of personal protective equipment (PPE) to protect against respiratory and dermal hazards for specific tasks. At a minimum, NIOSH recommends the use of a P-100 half-mask filtering facepiece respirator (or higher), gloves, eye protection, and protective clothing to protect against possible fentanyl exposure. In the event of a large spill or release of fentanyl, NIOSH recommends that law enforcement vacate the area and call a hazardous materials incident response team for support.

NIOSH is currently working on recommendations specific to healthcare providers in the hospital setting. Until those recommendations are completed, NIOSH recommends healthcare workers follow the current guidelines which you referenced in your comment:

Standard safe work practices must be applied to all operations where fentanyl or its analogs are known or suspected to be present, just as they are applied to any [healthcare] operation involving potential narcotics, such as a methamphetamine lab or heroin. [Workers] should not eat, drink, or smoke in the area of the suspected fentanyl and should wash their hands and inspect clothing for contamination after performing any activity potentially involving fentanyl. It is important that a job hazard analysis be performed to determine the most appropriate level and type of personal protective equipment (PPE) to protect against respiratory and dermal hazards for specific tasks. At a minimum, NIOSH recommends the use of a P-100 half-mask filtering facepiece respirator (or higher), gloves, eye protection, and protective clothing to protect against possible fentanyl exposure. In the event of a large spill or release of fentanyl, NIOSH recommends that [workers] vacate the area and call a hazardous materials incident response team for support.

There are many Facebook posts today( after a individual ripped open a baggie in a emergency room in NH and some of the emergency room employees felt ill,) , claiming that fentynal can not be absorbed through the skin…at all…in it’s powdered form.

They are claiming these employees are having a hysterical reaction and are causing hysteria in the public. That it needs the delivery compound found in fentynal patches only, to be able to go through the skin to affect anyone at all. Is this true?

They are claiming that over 700 doctors are claiming this. I have done many searches today and can find no information about any doctors or proof of this. I find it hard to believe. That is why I am asking you, for the correct answer.
Thank You.

The potential exposure routes for fentanyl of greatest concern include inhalation, mucous membrane contact, ingestion, and percutaneous exposure (e.g., needlestick). Any of these exposure routes can potentially result in a variety of symptoms that can include the rapid onset of life-threatening respiratory depression. Skin contact is also a potential exposure route, but is not likely to lead to an overdose unless large volumes of highly concentrated powder are encountered over an extended period of time. Brief skin contact with powdered fentanyl or its analogues is not expected to lead to toxic effects if any visible contamination is promptly removed using soap and water. It is important when fentanyl is suspected that precautions are taken to prevent it from becoming airborne.
NIOSH does not have specific information on what occurred in New Hampshire. We are working on guidance for the healthcare community. In the meantime, healthcare facilities should conduct a risk assessment to identify the potential hazards and appropriate precautions to protect workers. At a minimum, healthcare workers should follow the guidance provided for pre-hospital patient care found at https://www.cdc.gov/niosh/topics/fentanyl/risk.html. This includes specialized training to recognize fentanyl and how to properly protect yourself from exposure. For minimal exposures (fentanyl is suspected but not visible), the recommendation for personal protective equipment is to wear nitrile gloves. For moderate exposures (small amounts of powdered fentanyl is visible) nitrile gloves and a NIOSH approved N100 respirator should be worn.
We would like to hear from healthcare workers about the safety procedures and practices that you use when you suspect the presence of fentanyl. Please provide your input in the comment section below and let us know if you’re interested in learning more about the NIOSH Health Hazard Evaluation Program.

Are there any peer reviewed studies which cover or relate to the efficacy of 4 mil versus 5 mil versus 6 mil nitrile gloves in preventing fentanyl exposure in tactical and/or laboratory environments? I am wondering how, after looking at the molecular structure of fentanyl, NIOSH decided that 5mil nitrile gloves were a better choice than 4 mil or 6 mil gloves?

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